epatitis B, which is caused by the hepatitis B virus (HBV), is a potential life-threatening liver infection and the most serious type of viral hepatitis. As the World Health Organization reported, 1 approximately 2 billion people have been infected with HBV worldwide, and more than 350 million people have chronic hepatitis B. In China, the most common viral hepatitis is type B. The final evolutionary stage of chronic hepatitis B is liver cirrhosis. Portal hypertension is a major cause of esophageal varices, which have been reported to occur in up to 90% of patients with cirrhosis. 2 -Ping Ye, MM, Hai-Tao Ran, MD, Juan Cheng, MM, Ye-Feng Zhu, MM, Da-Zhi Zhang, MD, Ping Zhang, MD, Yuan-Yi Zheng, MD Received November 14, 2011, Methods-Two hundred sixty-four participants, of whom 60 were healthy volunteers (classified as stage 0), 66 were patients with chronic hepatitis B who had undergone liver biopsy, and 138 were patients with hepatitis B-related cirrhosis, were enrolled in this study. Median liver and spleen stiffness values (meters per second) from 10 successful measurements per participant were obtained. Patients with cirrhosis were examined by upper endoscopy.
XiaoResults-Significant linear correlations were found between liver (Spearman ρ = 0.87; P < .001) and spleen (Spearman ρ = 0.76; P < .001) stiffness and the fibrosis stage.Liver and spleen stiffness values increased as fibrosis progressed; however, overlaps in liver stiffness were detected in stages 0 and 1 and 1 and 2, and overlaps in spleen stiffness were observed in stages 0 and 1, 1 and 2, and 2 and 3. Liver stiffness cutoff values were 1.69 m/s for predicting stage 3 or greater (area under the receiver operating characteristic curve [AUROC] = 0.99) and 1.88 m/s for stage 4 (AUROC = 0.97). The spleen stiffness cutoff value was 2.72 m/s for stage 4 (AUROC = 0.96). Liver stiffness was not correlated with the varix grade, whereas a significant linear correlation (Spearman ρ = 0.65; P < .001) between spleen stiffness and the varix grade was found. The optimal spleen stiffness cutoff value for predicting varices was 3.16 m/s (AUROC = 0.83).Conclusions-Liver and spleen stiffness values measured by ARFI elastography are reliable predictors of liver fibrosis. Spleen stiffness measured by ARFI can be used as a noninvasive method for determining the presence and severity of esophageal varices; however, evidence to support a similar role for liver stiffness is lacking.